Tuesday, April 20, 2010

Decisions and Research

Lately, I have been listening to the Creating a Family podcast. In a recent show, they discussed the topic of writing out a plan for infertility treatment. This really resonated with me, as I (obviously) love to plan things!

Seriously though, as Ryan and I venture into the ‘fertility treatment’ world, I think it is a great idea that we first sit down and write a few things out. Seems right now, when we are clear-headed, hormone-free, and not wrapped up in the process, it is a good time to talk about some of the tough decisions and get on the same page.

For example, in a brief 30 second conversation with Ryan a few days ago, I found out that he would lean towards IVF before pursuing adoption. I had recently come to that conclusion for myself as well, although we hadn’t talked about it. As far as both of us knew, we thought the other would prefer adoption first, because that has always been how we talked about it. Funny that we each made that change individually.

So lately, I have been researching what some of these tough decisions will be and trying to get my thoughts together about how we’d approach them. Now that we’ve added IVF to the table, there are many more decisions to think about.

The following is a perfect example of why I want to think about these things ahead of time…

What do you do with ‘leftover’ frozen embryos?

In researching this, I was surprised to discover that most people did not think about this issue prior to pursuing IVF. I can understand why. At this point, you have tried for years to conceive, so not only is the thought of the procedure actually working hard to believe, you can’t even imagine that there would be embryos remaining after all is said and done.

That being said, I am trying to learn from others’ difficulties, and discuss with Ryan ahead of time how we might approach this. I consider embryos to be life, so I feel I need to have a plan for them before I ‘create’ them. As Ryan and I talk about our fertility treatment plan, I imagine we are going to set certain guidelines that will help in avoiding this situation, but should we get there anyway, I want us to be on the same page.

Here are the options available for frozen embryos, as it sits now. If you know of anything else, please pass that information along.

1. Continue having children until all embryos are gone: This is ideal, but sometimes not always an option, especially if many eggs were fertilized and children came quickly. It is not uncommon for women to have 20+ embryos in frozen storage. I hope to avoid this scenario by forming some guidelines, as mentioned above.

2. Thaw and dispose: Exactly as it sounds. The lab will thaw the embryos to room temperature for about an hour. They die on their own, and the ‘straws’ they are held in are disposed of into a biohazard waste container. Some parents collect the straws and will perhaps bury them in a special place.

3. Donating to research: In this situation, the embryos are used to try to find medical advances in a variety of fields, stem-cell research being one of the most discussed.

4. Compassionate Transfer: This is a newer idea in which the embryos are transferred to the mother without the necessary preparation for pregnancy to occur. While it might be possible that a pregnancy could result, it is very unlikely, and the embryos die inside the mother’s body.

5. Embryo adoption: This process is similar to a live adoption. ‘Donating’ parents choose a waiting couple and the adoption process flows accordingly. The adoption can be ‘open’ or ‘closed’.

6. Store indefinitely: Couples pay the storage fee each year, and leave embryos as is. Put more bluntly, this is deciding not to decide. At some point, the parents would pass away, leaving the next generation to decide what to do with these embryos at that time.

There are a couple options that sound okay and some I’d never do. This is why it is so important to talk about this ahead of time. I’ve heard women talk about the decisions they made ‘in the heat of the moment’, that they later regret. For example, one mother spoke of agreeing to fertilize all 30 eggs that were retrieved during her 'fresh' IVF cycle. She was desperate to begin her family, and without stopping to think about it, she simply went according to her doctor's recommendation. Four children later, she sat wondering what to do with the 23 embryos that remained.

Although I can’t guarantee that I won’t end up making spontaneous and emotional decisions at some point, I’d like to prevent it as much as possible by facing these questions now. I have a few other tough issues that I’m researching (minimal stimulation for IUIs, “natural” IVF cycles, etc). Through these discussions with Ryan and a lot of prayer, I hope to have a basic plan for how we’d like our treatment might flow by our May doctor’s appointment.


Hillary said...

My husband and I did IVF thinking that we'd discussed every possible scenario that could come up. Wrong. In all the preparatory paperwork, our clinic had us go through a 10 page consent form, where we had to list our wishes for what would happen to our embryos if I died, if he died, if we got divorced, if we remarried, etc. It really made us think.

However, our doctor told us that at least at their clinic, frozen embryos are rare. I went into IVF thinking that not only would I get pregnant, but I'd have enough frozen embryos to create my whole family. Wrong again. At our clinic, they tend to stimulate conservatively, which means fewer eggs retrieved and fewer embryos. We ended up with nothing to freeze and no pregnancy. However, I'm still glad that we took the time to think and pray and discuss all the possibilities and decided what we'd do. I applaud you for your careful thinking, and wish you luck for whatever you decide to do. Fertility treatments like IVF might seem scary, but much less so when you educate yourself first and then actually experience them. You'll do beautifully.

Selma & Danny said...


I've been following your blog for a while. So glad this topic came up as I just recently underwent my 1st IVF cycle after 7 failed infertility treatment cycles (3 clomid + 4 IUI cycles).

I am on the same page as you when it comes to considering embryos a life because they are. I remember getting a fertilization report from the embryologist and feeling instant attachment to those little cells.

I'm glad you and your husband had a conversation about this early on as those are very important ethical issues that should be carefully considered. A good RE will typically start with a fairly conserative does of stims and then increase/lower it as necessary. Women with certain conditions like PCOS for exaple may require low dose while some women wih high FSH may require very high does to even get few eggs. So I think it's important to get a good RE who will try best to find the "middle ground". Also one thing to remember is that not all embryos have potential to become babies so even if you have 10 frozen embryos there is a good chance that not all of them would eiter survive the thawing process or result in pregnancy. Just as an example I had 15 eggs retrieved.I was told that was an average. 14 were mature, 8 fertiized, 2 didn't make it,two were transfered. Both implanted but one stopped growing at 7 weeks. My husband and I are so greatful that we have our frozen embies waiting for us when we are ready for more children. I actually still think of them sometimes. In case we are not able to use all of our frozen embryos we have decided to make them available for adoption.

I'm so happy that you guys are open to IVF. After my four failed IUI's I was really concerned to make the leap to IVF. I think fear of failure was the worst. I told myself even if it didnt work the first time at least I could find out more answers about my unexplained infertility.

I wish you guys the best of luck and when things get rough just try to remember that grand prize in the end. DH and I will make sure to keep you guys in our prayrs!


Luna said...

You are one smart cookie! It is SUCH a good decision to have those discussions before hand. Look at all the options and thoughts just from one question!

When we had Kaiser I had to take their class on infertility treatment and they had a HUGE list of questions to consider. It is true, having a plan will help you in the future, even if you don't follow it exactly.

PLUS... you get to dream and fill your tank with Hope. What a power we have when we have hope!

Hillary said...

I can relate to all of your research and concerns! Deciding to do IVF was a huge and emotional process for us. We, too, believe that embryos are life and wanted to honor that life God created. It sounds like you have done a lot of research already, so I just wanted to let you know that there is somebody else out there doing IVF "unconventionally" should you decide to go one of the lesser trod IVF paths as well. Not saying you have to do this, but we decided to limit fertilization to 3 eggs and transfer any that divided.

All the best to you and I commend you for thinking this through before you are in the throes of IVF. xxoo


Anonymous said...

I appreciated knowing all the options given and the years of research so many have had to go through to get to this point in today's fertility field.

Some of the choice options made me feel "sterile" and numb in my feelings for such a precious gift as 'life'...

Some made me excited and happy for the future for me as a Grandparent...

But the one that caught me spiritually and as a mother that once longed for a new baby of my own to cuddle and hold...to listen to as she cooed and watch her twinkling eye gaze back at me...my choice would be...after all is said and done...having the number of babies you feel that are enough to bless your home...it would be time to bless another family with the same joy you have had...

All the 'children in waiting' are Heavenly Father's gifts...what greater joy could one have than to give the 'gift of life' to another couple yearning for the same joy?

Open or closed adoption...Open...Why? Why not?

Who is a Mother of a Child?

A Mother of a child is the one who has not given birth...

A Mother of a child is one who comforts her child at 2AM because baby is hungry, uncomfortable, afraid or lonely...and when her job is done...goes back to her room knowing her baby has drifted off into sweet dreams because of her love...

A Mother of a child is the one who kisses the skinned knees...puts cutzy bandages on and holds her breath when her child goes out to play again...

A Mother of a child is the one who helps comfort a broken heart... when the tears won't stop...gives comforting words of encouragement...then goes to her room to cry...

A Mother is the one who holds the lamp in the darkness...as her child grows into adulthood... wondering if she taught them enough to make it through life...

A Mother is the one whos always the cheer leader...confidant...and special friend...and quietly in the darkness wonders if she said the right thing...

A Mother is the one, in the end... that has spent her life BEING a Mother...not just a title...

Love you my Precious...
Your Mother